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rurc urrik-c u,,)r-: PLICATION FOR SANITATION PE IT Permit No. --- ----------- --- ------- ------------ --- (Complete in Duplicate) /44 Date Issued _---------------------------------- ---- --- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and 1 I1�kherein escrbed. This application is made in compliance with CQountyy Ordinance No. 549. %�6 q 9 4 t *6 ADDRESS AND LO ATION ''.-` "r o_X-_�t e-----os kn--j1�1-- d. ---- JOB ' Owner's Name-----------------� Yell --�----------- rte -------------- Phone. _.p .I -/ Address------------------1\-t--�------- - ----------- Y----- Contractor's Name-------- -- � Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Comme,rPial ['Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size --------. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .57 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 1--Hardpan ❑ Previous Application Made: (if yes,date....................) No NNew Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [T TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public�sewer is available within 200 fe?t.) N Septic k: Distance from nearest w I1-,,§s Mj�istan d rom�f u 9tion�1P.x14_%.Materia _ _:_C .�/- _'-__-___. ___ . --T.---- Size_ - .---Liquid d p.th-----�J� � Capacity � -- �t No. of compartments_._._ _ I Disposal field: Distance from nearest well 6d, �pistance from foundation_f _ &I E_)K4 r [/-r fes,-Distance to nearest lot life__ Number of lines_-_-__:._/__--- 8!g__. r Width ofgtrench.__._ ..__ t Type of filter material_ '_.B_� , Depth hofff lterlmaterial�_._./�.___ Total len th-----------------I 6--___________ Seepage Pit: Distance to nearest well----__ ______________Distance from foundation____-_-__-___•_____.Distance to nearest lot line__--_____-__-_-__ ❑ Number of pits----------------------Lining material------; -- -- --------Size: Diameter------------ ...... ---Depth_------------------------------- Cesspool: Distance from nearest well----------------_Distance from foundation------.-------------Lining material-------.------------._____.__.______- ❑ Size: Diameter----------- ------------ -------------Depth----------------------------------------------------Liquid Capacity__----------------------gals. f Privy: Distance from nearest well------------------------------------------------ Distance from nearest building---:'________.__--___________._._____._El . (r Distance to nearest lot line --- ---------------------=--------------- --•--------------------------------------------------•------- --- - -----.... - Remodeling and/or repairing (describe):_----67�-.__.__:_13ed-___._Ki _ _ ex_ --------- !�- - ---------- ----------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------- ----------------------------------- ---------- -------------------------------------------------------------------------------------------------------------------------- -----------------------------.- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rules and reg I tions of the San Joaquin Local Health District. 0 (Signed ned - - ---- --------------- ~`2 ........ ------------:------------------------I-- ----------------------------(Owner and/or Contractor) G 9 )----- --- - ----- --- --•------------------:-------------------=------------------------------------ -------(Title)--------------------------------------- _.. ..-- ----- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- ------------------------- ------------- ----- --- ---- - ATE---------/ ` REVIEWEDBY--------------------------------------------- ----------------------------- ------------------------------- ----------------- DATE----_---------- ------------------------------ BUILDING PERMIT ISSUED........................ ----- -- ----- DATE---------- Alterations and/or recommendations:-------.� y._---�L.4 ----- i -Q_,.- -G�� --- ------•��---�--- -------------------- ------------------- -------------- ------------------------ -�I ------ ..... F t - ----- --- - - ---------- ---------------------- ------------------- ----------------------- �,��C�G� ----- --------------------------_ -------------------------- -------------------------------- - - ----------------------------------------------------- ---------- FINALINSPECTION BY---------------------------------------------------------------- Date------- - ------------- ------------------ ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD.